*2.12.2 Atkins/keto diet*

The Atkins diet was promoted by Dr. Robert C Atkins, a cardiologist and recommended a low carbohydrate with high protein and fat diet. There are several modifications now available and are referred to as Keto diet. This diet shifts the energy needs of the body from carbohydrate to fats, therefore, The diet includes sources of high fat content like butter, nuts and cream [25]. The low carbohydrate diet recommends the use of 100 g/d of carbohydrates with 50–60% fat and 20–30% protein and the very low carbohydrate diet recommends <50 g/d of carbohydrates. Weight loss, low insulin levels, deceased hunger are some of the benefits reported [26, 27]. In T1DM patients the carbohydrate levels have to be adjusted to the insulin levels to maintain post prandial glucose levels and reduce hypoglycemia [28]. The preferred source of energy in the body is glucose, restricting this macronutrient forces the body to use fats for energy production. Unfortunately, when this happens many ketone bodies are produced and this is deleterious to the metabolism especially in the long run.

#### *2.12.3 Nutrisystems*

A meal plan for losing weight was proposed by Nutrisystems. This diet is customized to individuals for three meals and snacks per day. These diets are balanced and claims to be easy to prepare. The foods used are low glycemic carbohydrates, high fiber and lean proteins with no artificial sweeteners or flavors. Customers are expected to pick from basic, vegetarian, uniquely your, uniquely your ultimate, basic diabetss, diabetes-uniquely yours, ultimate diabetes as well as diet for men. Customers are given the option of picking their own meals or from customized meals. A couple of small (10 and 69 participants) short term (three months) studies used a portion controlled Nutrisystem diabetic diet to determine the effects on weight loss and diabetes. They reported that obese T2DM patients may show significant improvements in weight and glycemic control [29, 30]. A slightly larger study (100 participants) conducted for six months using Nutrisystem diabetes diet reported significantly increased weight loss with statistically insignificant reduction of HbA1C [31]. As this diet is more flexible than the other diets, it may be beneficial to individuals who carefully adhere to the diet and instructions.

Many other modified diets such as South Beach Diet, Zone diet, Macrobiotics, Blood group diet, Ayurvedic diets, Raw food diets, Cleansing diet, Crash diets, Calorie restricted diet are also available. These diets focus on reducing body weight and the major recommendations include decreased or no processed foods, more fiber, vegetables and fruits and decreased total fat intake [32, 33]. Care has to be taken to avoid any vitamins and mineral deficiencies.

#### **3. Nutritional supplements**

The use of natural products as therapy was in practice for many centuries in different parts of the world. This practice relates very well with the idea that food is medicine. Some of these practices are classified as traditional medicine. Around the world there is an increase interest in using these medicines which are categorized under complementary and alternative medicines. In developing countries, 90% of the population seek plant products as alternative treatment options [34]. The most important benefit could be that there are less or even no side effects and is cost effective. However, the main constraint for these products not being popularly recommended, is the limited scientific evidence about the efficacy, mechanism and side effects. But this is slowly changing as in the past few decades, scientific literature with information on the efficacy, side effects and mechanism of action of several natural products and their compounds has increased. Some of these different natural products that are not only implicated in controlling diabetes but also decrease other medical complications that arise due to diabetes [35].

Plant products are unique in that they have several ingredients and the active ingredient(s)/compound(s) are attributed to having the main effect. This has led the pharmaceutical industry to use some of these active ingredients in currently available allopathic drugs [36]. It is important to identify these active ingredients and study their effects to understand their mechanisms of action. However, it has been observed that when these compounds are isolated, they are sometimes not as efficient when compared to the whole extracts and this maybe because the other ingredients, although in small quantities, may influence the activity of the main compound.

High blood glucose can be due to several different factors apart from consumption of high levels of carbohydrates and inactivity. When the patient is diagnosed with hyperglycemia, they are advised about food intake and increasing physical

**329**

*Nutritional Interventions: Diet Modifications, Nutritional Supplements, Complementary…*

activity by entering an exercise program. There are drugs and nutritional supplements that will reduce the absorption of glucose in the intestines by inhibiting enzymes such as α amylase and α glucosidase, thereby, lowering postprandial glucose [37]. However, it has been recognized that there are many other factors such as pancreatic dysfunction, insulin resistance, imbalanced rate of glycogenolysis and gluconeogenesis and increased glucagon production result in increased production of endogenous glucose [38]. In addition, these patients may also have less insulin production with progressive β-cell dysfunction [39]. Therefore, diabetic patients may benefit more with plant products as these have multiple compounds that may

Traditional medicines have been popular in different parts of the world and some of them have been traced back to thousands of years - Chinese traditional medicine and Ayurveda. Many cultures around the world such as the American Indians, Mexican, Chinese, Indian subcontinent, various parts of Europe, Africans, Australians have incorporated locally available plants to treat diabetes [36]. Chinese traditional medicine describes bitter flavor and plants that release heat as the most important factors for treating T2DM [44]. Bitter flavor can consolidate the body, remove dampness and purge heat while cold property removes heat syndrome which is seen in T2DM patients during the initial and middle stages of the condition [44]. Ayurvedic treatment uses different approaches including plant medicines incorporated in the diet, exercise, medications, massage, sunlight, controlled

There are hundreds of plants that are used in different traditional medicines to treat diabetes. We have listed a few of the most promising common plants that have anti-diabetic activity in animal models and human studies with minimum side effects in **Table 1**. A commonly used vegetable in Asia and Africa is bitter melon (*Momordica charantia*) (**Figure 2A**). This has multiple anti diabetic properties when consumed as fresh juice or eaten regularly. Side effects reported so far is diarrhea [44, 46–51]. Spices used in a wide variety of cuisines around the world like cinnamon (*Cinnamomum*) and some used in the Indian subcontinent such as fenugreek (*Trigonella foenum*) are also implicated in controlling hyperglycemia (**Figure 2B** and **C**). They are widely used in North Africa, Asia and South Europe to treat diabetes. Prolonged use of cinnamon may cause gastrointestinal problems, allergic reactions and liver disease in sensitive people due to the presence of coumarin. Little is known about the side-effects of fenugreek and is safe in amounts that are used for cooking, however, large doses may cause diarrhea, nausea and gastrointestinal issues [46, 52–64]. Green tea (*Camellia sinensis*) is now a common beverage around the world, although it has been used in East Asia for centuries. It has some benefits to diabetic patients and the side effects include insomnia, nausea and heartburn [65, 66] (**Figure 2D**). Basil (*Oscimum basilicum*) and gurmar (*Gymnema sylvestre*) are used in Ayurvedic medicine. Gurmar has many antidiabetic properties compared to basil. Consumption of high levels of basil may cause

liver damage, while Gurmar may cause hypoglycemia headache and nausea [46, 67–72]. Prickly pear (*Opuntia ficus-indica, Opuntia matudae*) is used widely in Central and South America as a vegetable. The health benefits of this fruit include anti-diabetic properties. Mild diarrhea with nausea when consumed in large quantities are the reported side-effects [73–76]. Chinese rhubarb (*Rheum palmatum*) has been studied for its anti-diabetic properties and has been in use in Chinese traditional medicine for a long time. Side effects reported are constipation, diarrhea, stomach pain and inflammation of the pancreas. [44, 77]. Overall, these plants have been part of cuisines for centuries. More long term randomized trials in different ethnic populations will be more informative. The side-effects should be considered, as understanding and keeping track of the side-effects will help in dose determination and sensitivity among patients. Another important factor to consider is the ethnic

*DOI: http://dx.doi.org/10.5772/intechopen.94645*

affect multiple targets [40–43].

breathing and detoxification [45].

*Nutritional Interventions: Diet Modifications, Nutritional Supplements, Complementary… DOI: http://dx.doi.org/10.5772/intechopen.94645*

activity by entering an exercise program. There are drugs and nutritional supplements that will reduce the absorption of glucose in the intestines by inhibiting enzymes such as α amylase and α glucosidase, thereby, lowering postprandial glucose [37]. However, it has been recognized that there are many other factors such as pancreatic dysfunction, insulin resistance, imbalanced rate of glycogenolysis and gluconeogenesis and increased glucagon production result in increased production of endogenous glucose [38]. In addition, these patients may also have less insulin production with progressive β-cell dysfunction [39]. Therefore, diabetic patients may benefit more with plant products as these have multiple compounds that may affect multiple targets [40–43].

Traditional medicines have been popular in different parts of the world and some of them have been traced back to thousands of years - Chinese traditional medicine and Ayurveda. Many cultures around the world such as the American Indians, Mexican, Chinese, Indian subcontinent, various parts of Europe, Africans, Australians have incorporated locally available plants to treat diabetes [36]. Chinese traditional medicine describes bitter flavor and plants that release heat as the most important factors for treating T2DM [44]. Bitter flavor can consolidate the body, remove dampness and purge heat while cold property removes heat syndrome which is seen in T2DM patients during the initial and middle stages of the condition [44]. Ayurvedic treatment uses different approaches including plant medicines incorporated in the diet, exercise, medications, massage, sunlight, controlled breathing and detoxification [45].

There are hundreds of plants that are used in different traditional medicines to treat diabetes. We have listed a few of the most promising common plants that have anti-diabetic activity in animal models and human studies with minimum side effects in **Table 1**. A commonly used vegetable in Asia and Africa is bitter melon (*Momordica charantia*) (**Figure 2A**). This has multiple anti diabetic properties when consumed as fresh juice or eaten regularly. Side effects reported so far is diarrhea [44, 46–51]. Spices used in a wide variety of cuisines around the world like cinnamon (*Cinnamomum*) and some used in the Indian subcontinent such as fenugreek (*Trigonella foenum*) are also implicated in controlling hyperglycemia (**Figure 2B** and **C**). They are widely used in North Africa, Asia and South Europe to treat diabetes. Prolonged use of cinnamon may cause gastrointestinal problems, allergic reactions and liver disease in sensitive people due to the presence of coumarin. Little is known about the side-effects of fenugreek and is safe in amounts that are used for cooking, however, large doses may cause diarrhea, nausea and gastrointestinal issues [46, 52–64]. Green tea (*Camellia sinensis*) is now a common beverage around the world, although it has been used in East Asia for centuries. It has some benefits to diabetic patients and the side effects include insomnia, nausea and heartburn [65, 66] (**Figure 2D**). Basil (*Oscimum basilicum*) and gurmar (*Gymnema sylvestre*) are used in Ayurvedic medicine. Gurmar has many antidiabetic properties compared to basil. Consumption of high levels of basil may cause liver damage, while Gurmar may cause hypoglycemia headache and nausea [46, 67–72]. Prickly pear (*Opuntia ficus-indica, Opuntia matudae*) is used widely in Central and South America as a vegetable. The health benefits of this fruit include anti-diabetic properties. Mild diarrhea with nausea when consumed in large quantities are the reported side-effects [73–76]. Chinese rhubarb (*Rheum palmatum*) has been studied for its anti-diabetic properties and has been in use in Chinese traditional medicine for a long time. Side effects reported are constipation, diarrhea, stomach pain and inflammation of the pancreas. [44, 77]. Overall, these plants have been part of cuisines for centuries. More long term randomized trials in different ethnic populations will be more informative. The side-effects should be considered, as understanding and keeping track of the side-effects will help in dose determination and sensitivity among patients. Another important factor to consider is the ethnic

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

A meal plan for losing weight was proposed by Nutrisystems. This diet is customized to individuals for three meals and snacks per day. These diets are balanced and claims to be easy to prepare. The foods used are low glycemic carbohydrates, high fiber and lean proteins with no artificial sweeteners or flavors. Customers are expected to pick from basic, vegetarian, uniquely your, uniquely your ultimate, basic diabetss, diabetes-uniquely yours, ultimate diabetes as well as diet for men. Customers are given the option of picking their own meals or from customized meals. A couple of small (10 and 69 participants) short term (three months) studies used a portion controlled Nutrisystem diabetic diet to determine the effects on weight loss and diabetes. They reported that obese T2DM patients may show significant improvements in weight and glycemic control [29, 30]. A slightly larger study (100 participants) conducted for six months using Nutrisystem diabetes diet reported significantly increased weight loss with statistically insignificant reduction of HbA1C [31]. As this diet is more flexible than the other diets, it may be beneficial

Many other modified diets such as South Beach Diet, Zone diet, Macrobiotics, Blood group diet, Ayurvedic diets, Raw food diets, Cleansing diet, Crash diets, Calorie restricted diet are also available. These diets focus on reducing body weight and the major recommendations include decreased or no processed foods, more fiber, vegetables and fruits and decreased total fat intake [32, 33]. Care has to be

The use of natural products as therapy was in practice for many centuries in different parts of the world. This practice relates very well with the idea that food is medicine. Some of these practices are classified as traditional medicine. Around the world there is an increase interest in using these medicines which are categorized under complementary and alternative medicines. In developing countries, 90% of the population seek plant products as alternative treatment options [34]. The most important benefit could be that there are less or even no side effects and is cost effective. However, the main constraint for these products not being popularly recommended, is the limited scientific evidence about the efficacy, mechanism and side effects. But this is slowly changing as in the past few decades, scientific literature with information on the efficacy, side effects and mechanism of action of several natural products and their compounds has increased. Some of these different natural products that are not only implicated in controlling diabetes but also decrease

Plant products are unique in that they have several ingredients and the active ingredient(s)/compound(s) are attributed to having the main effect. This has led the pharmaceutical industry to use some of these active ingredients in currently available allopathic drugs [36]. It is important to identify these active ingredients and study their effects to understand their mechanisms of action. However, it has been observed that when these compounds are isolated, they are sometimes not as efficient when compared to the whole extracts and this maybe because the other ingredients, although in small quantities, may influence the activity of the main

High blood glucose can be due to several different factors apart from consumption of high levels of carbohydrates and inactivity. When the patient is diagnosed with hyperglycemia, they are advised about food intake and increasing physical

to individuals who carefully adhere to the diet and instructions.

taken to avoid any vitamins and mineral deficiencies.

other medical complications that arise due to diabetes [35].

**3. Nutritional supplements**

*2.12.3 Nutrisystems*

**328**

compound.


*PP = post prandial, HbA1C = Hemoglobin A1C, GLUT4 = Glucose transporter 4, PEPCK = Phosphoenol pyruvate carboxy kinase, PI3K = Phosphoinositide 3-kinase, PPAR = Peroxisome proliferator-activated receptor.* ↓ *= decrease,*  ↑ *= increase.*

**331**

interest.

**Figure 2.**

polyphenols.

*3.1.1 Saponins*

asparagus, spinach and tea.

**3.1 Active ingredients/compounds**

*(C) cinnamon sticks, (D) driedgreentea.*

*Nutritional Interventions: Diet Modifications, Nutritional Supplements, Complementary…*

background of the patient and their family history. This is very critical, as the response of patients to any therapy is dependent on these factors. This also calls for any medi-

Different parts of the plants are used – roots, stem, flowers, fruits and seeds.

Each part of the plant may have different concentrations of phytochemicals which are the main players in the health benefits they show. Different compounds have been isolated from the potential medicinal plants and studied for their effects on the different pathways that are involved in the medical condition of

*Some herbal products beneficial to diabetic patients. (A) Bitter melon, (B) Fenogreekseeds and leaves,* 

Some of the active ingredients have been characterized in either *in vitro* or *in vivo* studies including randomized control trials (RCT) for their anti-diabetic properties. Some of the common compounds studied are saponins, flavones, and

Saponins increase liver glycogen synthesis, inhibit glycogen breakdown and promote insulin sensitivity in the peripheral tissues by increasing Glut 4 expression [78, 79]. Saponins also decrease body weight and inhibit enzymes that breakdown glucose [79, 80]. Found in legumes such as broad beans and lentils, bitter melon,

cine or diet prescription/counseling to be more individual specific.

*DOI: http://dx.doi.org/10.5772/intechopen.94645*

#### **Table 1.**

*List of some plants beneficial to diabetic patients.*

*Nutritional Interventions: Diet Modifications, Nutritional Supplements, Complementary… DOI: http://dx.doi.org/10.5772/intechopen.94645*

**Figure 2.** *Some herbal products beneficial to diabetic patients. (A) Bitter melon, (B) Fenogreekseeds and leaves, (C) cinnamon sticks, (D) driedgreentea.*

background of the patient and their family history. This is very critical, as the response of patients to any therapy is dependent on these factors. This also calls for any medicine or diet prescription/counseling to be more individual specific.

Different parts of the plants are used – roots, stem, flowers, fruits and seeds. Each part of the plant may have different concentrations of phytochemicals which are the main players in the health benefits they show. Different compounds have been isolated from the potential medicinal plants and studied for their effects on the different pathways that are involved in the medical condition of interest.

#### **3.1 Active ingredients/compounds**

Some of the active ingredients have been characterized in either *in vitro* or *in vivo* studies including randomized control trials (RCT) for their anti-diabetic properties. Some of the common compounds studied are saponins, flavones, and polyphenols.

#### *3.1.1 Saponins*

Saponins increase liver glycogen synthesis, inhibit glycogen breakdown and promote insulin sensitivity in the peripheral tissues by increasing Glut 4 expression [78, 79]. Saponins also decrease body weight and inhibit enzymes that breakdown glucose [79, 80]. Found in legumes such as broad beans and lentils, bitter melon, asparagus, spinach and tea.

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

**Part of the plant used**

Bitter melon Fruit • ↓Glucose, HbA1C,

Cinnamon Bark • ↓Fasting glucose,

Fenugreek Seeds,

Leaves

Tea- green Leaves • ↓HbA1C

Gurmar Leaves • ↓Glucose levels

Nopal Fruit • ↓Intestinal absorption

Basil, Tulsi Leaves • ↓A glucosidase, a amy-

Root • ↓HbA1C, glucose,

*PP = post prandial, HbA1C = Hemoglobin A1C, GLUT4 = Glucose transporter 4, PEPCK = Phosphoenol pyruvate carboxy kinase, PI3K = Phosphoinositide 3-kinase, PPAR = Peroxisome proliferator-activated receptor.* ↓ *= decrease,* 

**Anti-diabetic properties Area** 

fasting and PP glucose, PEPCK. • ↑Glucose uptake in cells, insulin signaling, GLUT4, PI3K, PPAR. • Antioxidative and anti inflammatory

HbA1C, PEPCK. • Mimics insulin in rodents, anti inflammatory, improves insulin sensitivity

• ↓Glucose, HbA1C, PP

glucose. • ↑Insulin secretion • Renew pancreatic b

cells

• Improves insulin sensitivity, glucose tolerance

• ↑Insulin secretion, promotes islet cell regeneration, delays glucose absorption • binds to the receptors for sweet in the taste buds and inhibit sugar from binding

of glucose, PP glucose • Improves insulin sensitivity, anti-oxidative

lase, hyperglycemia • ↑Insulin stimulated glucose metabolism, GLUT4 translocation, liver glycogen content

insulin resistance

**traditionally used as medicine**

Africa, China, India,

China, India, Persia

India, South Europe, Mediterranean

Central and South America

South East Asia

Chinese [26, 59]

Global [47–48]

India [28, 52–54]

[55–58]

[49–51]

**References**

[26, 28–33]

[36–40, 42, 46]

[34, 35, 41, 43–45]

**Plant Common** 

*Momordica charantia*

*Cinnamomum*

*Trigonella fienum-graecum*

*Camellia sinensis*

*Gymnea sylvestre*

*Opuntia ficus-indica, O. matudkae*

*Oscimum basilicum*

*Rheum palmatum*

↑ *= increase.*

**Table 1.**

Chinese Rhubarb

*List of some plants beneficial to diabetic patients.*

sp.

**name**

**330**

#### *3.1.2 Flavonoids*

Flavonoids are a group of compounds that are widely found in plant products and are implicated in several health benefits including T2DM. They inhibit enzymes that breakdown glucose and protect pancreatic β-cell damage, stimulate insulin secretion, promote glucose uptake in peripheral tissues, inhibit α amylase and α glucosidase and stimulate glycogenesis [43, 46, 80, 81]. Kaempferol inhibits hepatic inflammation, protects β cells by inhibiting apoptosis, lowers fasting glucose and improves insulin sensitivity [82–84]. They exhibit anti oxidative and anti-inflammatory properties as well [85]. Present in *Gingko biloba*, grapefruit broccoli, kale and tea. Anthocyanin also improves insulin sensitivity, decrease fasting sugar, in addition, it increases adiponectin and regulates glucose internalization via PPARγ, upregulates Glut4 and translocates Glut4 to membrane [86, 87]. It also increases AMPK in liver and muscle to increase glucose uptake and inhibit gluconeogenesis [88]. Found in tea, honey, nuts and many vegetables and fruits.

#### *3.1.3 Polyphenols*

Polyphenols are another group of compounds which include resveratrol, quercetin, epigallocathechin-3 gallate and triterpenoids have multiple targets in reducing hyperglycemia. Resveratrol reduces blood glucose, increases insulin secretion and modulates the enzymes of carbohydrate metabolism [89–91]. It also has anti-oxidative and by decreasing the production of proinflammatory cytokines it is anti-inflammatory as well [82]. Resveratrol is found in the skin of grapes, peanuts, coca, and berries like blueberries, bilberries and cranberries. Quercetin lowers body weight and decreases proinflammatory cytokines [92–94]. Onion has high quantities of quercetin but is also found in a variety of other vegetables and fruits including green leafy vegetable, apples, raspberries, red grapes and cherries. Epigallocathechin 3 gallate alters insulin secretion by increasing it and lowers glucose levels and body weight [95]. High levels are found in tea especially green tea. Triterpenoids can modulate insulin resistance [46, 49]. Found in bitter melon, olives, grapes, mango, apples, tomatoes and many other vegetables.

Alkaloids and polysaccharides present in plants may also control hyperglycemia [96].

### **4. Micronutrients**

#### **4.1 Minerals**

Minerals like chromium magnesium and vanadium can influence hyperglycemia and are used in medications to treat T2DM. Chromium is poorly absorbed with age and T2DM patients have decreased levels of chromium [97]. Studies have shown that chromium deficiency causes reversible insulin resistance and when supplemented improves glycemic control [57]. Another mineral that most T2DM patients show low levels is magnesium [36]. Magnesium is a cofactor for many enzymes in glucose oxidation and it modulates glucose across cell membranes. Mg deficiency causes insulin resistance. It may increase insulin secretion and increase uptake of glucose in peripheral tissues [36]. Vanadium was used in certain insulin preparations and in animal models has shown increased uptake of glucose and its metabolism. It is also reported to increase insulin sensitivity. It may modulate glucose oxidation, glycogen synthesis and hepatic glucose output modulation [98].

**333**

*Nutritional Interventions: Diet Modifications, Nutritional Supplements, Complementary…*

Vitamins like vitamin C and E may also help T2DM patients. Vitamin C can improve glycemic control [99] while vitamin E, as an anti-oxidant, may influence

Several diets have been studied to reduce the risk of developing diabetes and to control hyperglycemia. Almost all of them focus on decreasing body weight so they reduce body fat content as well. Many of the diets are beneficial in delaying the onset of diabetes and to diabetic patients. However, some of the diets require for the patients to be monitored constantly. Many plant products used in traditional medicine around the world have been scientifically studied to determine the efficacy, mechanism and side effects with focus of their effects on hyperglycemia. Diabetes being a complicated disease, T2DM patients may benefit more if multi targeted therapy is given. In addition to diet, another important factor that will help T2DM is the level of physical activity and exercise. Any diet with exercise is more beneficial

Mayo clinic recommends diet rich in fiber, vegetables, fruits and whole grain with low fat dairy products [100]. The American Diabetic Association and The American Heart Association recommend a balanced plate similar to that of USDA (**Figures 3** and **4**) with half plate of vegetables, a quarter plate of healthy carbohydrates such as brown rice, whole wheat couscous, whole grain pasta or plain sweet potato and some less than a quarter plate of protein [101, 102]. Fats are essential to the body as they are integral part of the cell membrane and hormones. They are required to digest any fat that is consumed. However, there has been a debate whether saturated fats are required for the body or not. The importance of having less than 10% saturated fat in the diet is now recognized although instead of saturated fatty acids, mono and poly unsaturated fatty acids are recommended. With respect to nutritional supplements there is no recommendation from American Diabetes Association. However, there is an increase in the number of patients seeking complementary and alternative medicine due to lower side effects and cost effectiveness. With a steady increase in scientific authentication of plant products for preventing and treating medical conditions nutritional supplements may become more popular. Interestingly, many of the plant products are consumed almost everyday in many cultures and these population also report diabetes. One reason maybe because they do not eat it everyday at the required dosage in addition to major change in lifestyle from an active on to a more sedentary one, as seen in any

With many options for diets to choose from for patients, it is important to remember that as individuals differ among themselves, a individualized diet is important and equally important is adhering to the diet [103]. For diabetic patients to help control the progression of the disease, it is important to consider bio individual needs of each patients. Whether it is the choice of drugs, nutrition therapy or life style changes, it is important to have individually tailored treatment regimens for diabetic patients based on several factors including the ethnicity, life style, choice of foods etc. Other important factors to consider, in T2DM patients, are how much endogenous insulin is produced, and the level of insulin resistance to recommend diets that can target β-cell function and tissue-specific insulin sensitivity [104]. In T1DM patients it is critical to monitor the insulin that is administered and adjust

*DOI: http://dx.doi.org/10.5772/intechopen.94645*

protein glycation, insulin sensitivity and secretion [36].

**4.2 Vitamins**

**5. Conclusions**

than either one alone.

developed societies.

*Nutritional Interventions: Diet Modifications, Nutritional Supplements, Complementary… DOI: http://dx.doi.org/10.5772/intechopen.94645*

### **4.2 Vitamins**

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

Flavonoids are a group of compounds that are widely found in plant products and are implicated in several health benefits including T2DM. They inhibit enzymes that breakdown glucose and protect pancreatic β-cell damage, stimulate insulin secretion, promote glucose uptake in peripheral tissues, inhibit α amylase and α glucosidase and stimulate glycogenesis [43, 46, 80, 81]. Kaempferol inhibits hepatic inflammation, protects β cells by inhibiting apoptosis, lowers fasting glucose and improves insulin sensitivity [82–84]. They exhibit anti oxidative and anti-inflammatory properties as well [85]. Present in *Gingko biloba*, grapefruit broccoli, kale and tea. Anthocyanin also improves insulin sensitivity, decrease fasting sugar, in addition, it increases adiponectin and regulates glucose internalization via PPARγ, upregulates Glut4 and translocates Glut4 to membrane [86, 87]. It also increases AMPK in liver and muscle to increase glucose uptake and inhibit gluconeogenesis

[88]. Found in tea, honey, nuts and many vegetables and fruits.

olives, grapes, mango, apples, tomatoes and many other vegetables. Alkaloids and polysaccharides present in plants may also control

Minerals like chromium magnesium and vanadium can influence hyperglycemia and are used in medications to treat T2DM. Chromium is poorly absorbed with age and T2DM patients have decreased levels of chromium [97]. Studies have shown that chromium deficiency causes reversible insulin resistance and when supplemented improves glycemic control [57]. Another mineral that most T2DM patients show low levels is magnesium [36]. Magnesium is a cofactor for many enzymes in glucose oxidation and it modulates glucose across cell membranes. Mg deficiency causes insulin resistance. It may increase insulin secretion and increase uptake of glucose in peripheral tissues [36]. Vanadium was used in certain insulin preparations and in animal models has shown increased uptake of glucose and its metabolism. It is also reported to increase insulin sensitivity. It may modulate glucose oxidation, glycogen synthesis and hepatic glucose output modulation [98].

Polyphenols are another group of compounds which include resveratrol, quercetin, epigallocathechin-3 gallate and triterpenoids have multiple targets in reducing hyperglycemia. Resveratrol reduces blood glucose, increases insulin secretion and modulates the enzymes of carbohydrate metabolism [89–91]. It also has anti-oxidative and by decreasing the production of proinflammatory cytokines it is anti-inflammatory as well [82]. Resveratrol is found in the skin of grapes, peanuts, coca, and berries like blueberries, bilberries and cranberries. Quercetin lowers body weight and decreases proinflammatory cytokines [92–94]. Onion has high quantities of quercetin but is also found in a variety of other vegetables and fruits including green leafy vegetable, apples, raspberries, red grapes and cherries. Epigallocathechin 3 gallate alters insulin secretion by increasing it and lowers glucose levels and body weight [95]. High levels are found in tea especially green tea. Triterpenoids can modulate insulin resistance [46, 49]. Found in bitter melon,

*3.1.2 Flavonoids*

*3.1.3 Polyphenols*

hyperglycemia [96].

**4. Micronutrients**

**4.1 Minerals**

**332**

Vitamins like vitamin C and E may also help T2DM patients. Vitamin C can improve glycemic control [99] while vitamin E, as an anti-oxidant, may influence protein glycation, insulin sensitivity and secretion [36].
